International Reflux Classification. Adapted from (2002) Vesicoureteral Reflux. In: Belman, King, Kramer (eds.) Clinical Pediatric Urology. London, England: Martin Dunitz, Ltd., 753.
The management of vesicoureteral reflux depends on the grade of reflux, which is determined by the VCUG. Also taken into consideration are the frequency of urinary tract infections, the presence and progression of any kidney damage, and parental opinion.
For grades I-III there is a good chance that the reflux will disappear as the child grows and the bladder matures. These children are given low-dose antibiotics daily, to suppress bacteria from growing. Occasional blood tests and urine cultures may be ordered.
An option for patients with grades I-IV is a cystoscopy with injection of Deflux. This is a procedure where under general anesthesia a small telescope is inserted into the bladder through the urinary opening. A gel (Deflux) is injected where the ureters enter the bladder. A little bulge is formed in the bladder wall, preventing the backflow of urine. This is an outpatient procedure.
Patients with "high grade" reflux, grades IV-V, will take low dose antibiotics and have periodic blood tests, X-ray tests and urine cultures done. These children will often need ureteral reimplantation surgery to correct the reflux and prevent progressive damage of the kidneys.
Ureteral Reimplantation Surgery
The goals of surgery are to correct the reflux, prevent pyelonephritis (kidney infection), and preserve renal function. The surgical repair of reflux may not totally stop the development of bladder infections. It will reduce the chance of a bladder infection developing into a kidney infection.
The ureteral reimplantation surgery consists of creating a longer tunnel of the ureter through the bladder wall. The surgery is performed through an incision (cut) just above the pubic bone (bikini incision). If both ureters need to be reimplanted, this is done through one incision.
This surgery usually lasts between 2½ and three hours. Afterwards, the child will be admitted to the hospital for two to four days. Before surgery, the anesthesiologist will discuss a pain management plan with the family.
After open surgery, activity will be limited for four to six weeks. No tub baths for five days. Return to school can be one week after surgery or when no longer taking narcotics for pain control.
After reflux surgery, there may be limitations on physical activity depending upon your surgeon. Voiding every two to three hours as well as drinking adequate fluids helps healing. Your child may return to school the day after surgery.